Medicaid

InnovAge CEO Maureen Hewitt: PACE Tailwinds Stronger Than Ever

InnovAge (Nasdaq: INNV) went public earlier this year with a $350 million IPO. It has since set its sights on expansion. The largest Program of All-Inclusive Care for the Elderly (PACE) organization in the country, InnovAge is bullish on its ability to do just that, thanks to both internal confidence and also external, regulatory tailwinds. …

InnovAge CEO Maureen Hewitt: PACE Tailwinds Stronger Than Ever Read More »

Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees

The COVID-19 pandemic and the ensuing economic disruption have drawn more attention to longstanding issues related to housing and internet access and how these issues can impact health. As the primary source of health insurance for low-income populations, Medicaid covers a considerable share of people living in homes that are unaffordable, inadequate, or have limited …

Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees Read More »

California’s Reboot of Troubled Medi-Cal Puts Pressure on Health Plans

When Denise Williams’ baby boy was 2 months old, she became alarmed by a rattling sound in his lungs and took him to the emergency room. While undergoing treatment, he spiraled into a disabling neurological disorder. Now 2 years old, Markeano is attached to breathing and feeding tubes. He can’t walk or move his arms. …

California’s Reboot of Troubled Medi-Cal Puts Pressure on Health Plans Read More »

Increasing LTSS Access Could Cost Up to $12.8 Billion Per Year

Access to long-term services and supports (LTSS) in the U.S. remains limited, which currently puts seniors in need in a bind. Their options are often such: spend down on savings and assets in order to qualify for Medicaid, or rely on unpaid family care or other informal services. A new study from the Washington, D.C.-based …

Increasing LTSS Access Could Cost Up to $12.8 Billion Per Year Read More »

Dentistas eliminan los problemas de las personas sin seguro ofreciéndoles ellos mismos planes

David White, dentista de Nevada, ha visto dientes enfermos y podridos en la boca de pacientes que habitualmente posponen sus chequeos y evitan procedimientos menores como empastes. Si bien la fobia dental es un factor, White dijo que la razón principal por la que las personas no se tratan es el costo. Para ayudar a …

Dentistas eliminan los problemas de las personas sin seguro ofreciéndoles ellos mismos planes Read More »

Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans

Nevada dentist David White has seen diseased and rotted teeth in the mouths of patients who routinely put off checkups and avoided minor procedures such as fillings. While dental phobia is a factor, White said, the overriding reason people avoid treatment is cost. To help patients lacking dental insurance, White in 2019 started offering a …

Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans Read More »

KHN’s ‘What the Health?’: Much Ado About Drug Prices

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. Congressional Democrats are finding it harder to actually write legislation to lower drug prices than it is to make promises about it. But the drug price provisions of the $3.5 trillion social-spending bill …

KHN’s ‘What the Health?’: Much Ado About Drug Prices Read More »

Sin papeles, sin atención: migrantes con discapacidades buscan ayuda a través de demandas y activismo

Hace 13 años, la desesperación llevó a José Luis Hernández a subirse a un tren que iba a alta velocidad en el norte de México con la esperanza de llegar a los Estados Unidos. Pero no lo logró. Resbaló y cayó bajo las ruedas de acero: perdió el brazo y la pierna derechas, y cuatro …

Sin papeles, sin atención: migrantes con discapacidades buscan ayuda a través de demandas y activismo Read More »

No Papers, No Care: Disabled Migrants Seek Help Through Lawsuit, Activism

Desperation led José Luis Hernández to ride atop a speeding train through northern Mexico with hopes of reaching the United States 13 years ago. But he didn’t make it. Slipping off a step above a train coupling, he slid under the steel wheels. In the aftermath, he lost his right arm and leg, and all …

No Papers, No Care: Disabled Migrants Seek Help Through Lawsuit, Activism Read More »

Census: Insured Population Holds Steady, With a Slight Shift From Private to Public Coverage

Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released Tuesday. Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%. During a …

Census: Insured Population Holds Steady, With a Slight Shift From Private to Public Coverage Read More »

Implications of the Medicaid Fiscal Cliff for the U.S. Territories

The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced an array of longstanding fiscal and health challenges that were exacerbated by recent natural disasters and most recently by the COVID-19 pandemic. Differences in Medicaid financing, including a statutory …

Implications of the Medicaid Fiscal Cliff for the U.S. Territories Read More »

38 States Have Increased HCBS Payments During the Pandemic

To keep vulnerable Americans at home and out of riskier long-term care settings during the pandemic, the U.S. Centers for Medicare & Medicaid Services (CMS) gave states an unprecedented ability to temporarily modify their Medicaid home- and community-based services (HCBS) programs. But while the emergency waivers issued by CMS helped limit the spread of the …

38 States Have Increased HCBS Payments During the Pandemic Read More »

Health Care Unions Defending Newsom From Recall Will Want Single-Payer Payback

SACRAMENTO, Calif. — Should Gavin Newsom survive the Republican-driven attempt to oust him from office, the Democratic governor will face the prospect of paying back supporters who coalesced behind him. And the leaders of California’s single-payer movement will want their due. Publicly, union leaders say they’re standing beside Newsom because he has displayed political courage …

Health Care Unions Defending Newsom From Recall Will Want Single-Payer Payback Read More »

Georgia Eyes New Medicaid Contract. But How Is the State Managing Managed Care?

Just before Frank Berry left his job as head of Georgia’s Medicaid agency this summer, he said the state “will be looking for the best bang for the buck” in its upcoming contract with private insurers to cover the state’s most vulnerable. But whether the state — and Medicaid patients — are getting an optimal …

Georgia Eyes New Medicaid Contract. But How Is the State Managing Managed Care? Read More »

It’s Not Just Covid: Recall Candidates Represent Markedly Different Choices on Health Care

SACRAMENTO, Calif. — Gov. Gavin Newsom’s covid-19 rules have been a lightning rod in California’s recall election. But there’s a lot more at stake for Californians’ health care than mask and vaccine mandates. Newsom, a first-term Democrat, argues that their fundamental ability to get health insurance and medical treatments is on the line. Republicans are …

It’s Not Just Covid: Recall Candidates Represent Markedly Different Choices on Health Care Read More »

Understanding the Impact of Medicaid Premiums & Cost-Sharing: Updated Evidence from the Literature and Section 1115 Waivers

Our review of recent literature on premiums and cost-sharing is based on studies and reports published between 2017 and 2021. Our analysis of premiums in post-Affordable Care Act (ACA) Section 1115 waivers (approved under the Obama and Trump administrations) is based on available interim and final waiver evaluations as well as annual and quarterly state …

Understanding the Impact of Medicaid Premiums & Cost-Sharing: Updated Evidence from the Literature and Section 1115 Waivers Read More »

Colorado Clinic’s Prescription for Healthier Patients? Lawyers

COMMERCE CITY, Colo. — In her 19 years of living with cerebral palsy, scoliosis and other ailments, Cynthia Enriquez De Santiago has endured about 60 surgeries and her heart has flatlined at least four times. But the most unusual doctor’s referral of her life came last year: Go see an attorney. Enriquez De Santiago sought …

Colorado Clinic’s Prescription for Healthier Patients? Lawyers Read More »

California Set to Spend Billions on Curing Homelessness and Caring for ‘Whole Body’ Politic

OAKLAND, Calif. — Living unmedicated with schizophrenia and bipolar disorder, Eugenia Hunter has a hard time recalling how long she’s been staying in the tent she calls home at the bustling intersection of San Pablo Avenue and Martin Luther King Jr. Way in Oakland’s hip Uptown neighborhood. Craft coffee shops and weed dispensaries are plentiful …

California Set to Spend Billions on Curing Homelessness and Caring for ‘Whole Body’ Politic Read More »

Beneficiarios de Medicaid se vacunan mucho menos contra covid

Los beneficiarios de Medicaid se están vacunando contra covid-19 a tasas mucho más bajas que la población general, mientras los estados buscan las mejores estrategias para mejorar el acceso a las vacunas, y persuadir a quienes siguen indecisos. Los esfuerzos de las agencias estatales de Medicaid y los planes de salud privados que la mayoría …

Beneficiarios de Medicaid se vacunan mucho menos contra covid Read More »

Medicaid Vaccination Rates Founder as States Struggle to Immunize Their Poorest Residents

Medicaid enrollees are getting vaccinated against covid-19 at far lower rates than the general population as states search for the best strategies to improve access to the shots and persuade those who remain hesitant. Efforts by state Medicaid agencies and the private health plans that most states pay to cover their low-income residents has been …

Medicaid Vaccination Rates Founder as States Struggle to Immunize Their Poorest Residents Read More »

Headed Away to School? Here’s What Students With Health Issues Need to Know

College is a time of transition, but for those managing chronic medical conditions, it may also be the first time they will be wholly responsible for their own health: setting appointments, securing supplies and pharmaceuticals, and monitoring symptoms. For those heading to schools far from home, it can be especially tricky navigating the complex world …

Headed Away to School? Here’s What Students With Health Issues Need to Know Read More »

Biden’s No-Jab-No-Job Order Creates Quandary for Nursing Homes

President Joe Biden’s edict that nursing homes must ensure their workers are vaccinated against covid-19 presents a challenge for an industry struggling to entice its lowest-paid workers to get shots without driving them to seek employment elsewhere. Although 83% of residents in the average nursing facility are vaccinated, only 61% of a home’s workers are …

Biden’s No-Jab-No-Job Order Creates Quandary for Nursing Homes Read More »

KHN’s ‘What the Health?’: Booster Time

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. As covid-19 cases in the U.S. continue to rise, the Biden administration is countering with new strategies. The latest efforts include preparing for vaccine boosters starting this …

KHN’s ‘What the Health?’: Booster Time Read More »

Cityblock Health & The ‘At-Risk’ Disruption of Medicaid Care

By JESSICA DaMASSA, WTF HEALTH Innovation in Medicaid is HAPPENING – and not only is it capable of creating better, less expensive healthcare for Medicaid members, but Cityblock Health is proving that it can also be the underpinning of a business worth over $1B dollars. Dr. Toyin Ajayi, Cityblock’s co-founder & President, walks through the …

Cityblock Health & The ‘At-Risk’ Disruption of Medicaid Care Read More »

Children Head Back to School Amid an Ongoing Pandemic That Has Had Significant Effects on Their Health and Well-Being

As students head back to in-person school this fall, a new KFF brief highlights the effects of the ongoing pandemic on the health and well-being of children, including missed routine vaccinations and preventive care, mental health challenges and economic setbacks that can influence health. There had been over 4 million COVID-19 cases among children as…More

Back to School amidst the New Normal: Ongoing Effects of the Coronavirus Pandemic on Children’s Health and Well-Being

As millions of children across the nation prepare to go back to school this fall, many will face challenges due to ongoing health, economic, and social consequences of the pandemic. This brief examines how the COVID-19 pandemic has affected the health and well-being of children, explores recent policy responses, and considers what the findings means …

Back to School amidst the New Normal: Ongoing Effects of the Coronavirus Pandemic on Children’s Health and Well-Being Read More »

KHN’s ‘What the Health?’: The Senate Acts

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Senate has set the stage for a busy fall that will include debate on a broad array of health issues, such as prescription drug prices, Medicare …

KHN’s ‘What the Health?’: The Senate Acts Read More »

Direct Care Workforce Shortages Have Worsened in Many States During the Pandemic, Hampering Providers of Home and Community-Based Services

During the pandemic many states have experienced worsening direct care workforce shortages that have affected providers of home- and community-based long-term care services (HCBS), according to early findings of a new KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. Most states reported workforce shortages as the pandemic’s primary…More

State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey

This issue brief presents early findings from the most recent KFF survey of Medicaid HCBS programs in all 50 states and the District of Columbia. It focuses on state policies adopted in response to challenges posed by the pandemic, the pandemic’s impact on Medicaid HCBS enrollees and providers, and states’ initial plans for the new …

State Medicaid Home & Community-Based Services (HCBS) Programs Respond to COVID-19: Early Findings from a 50-State Survey Read More »

Medicaid Authorities and Options to Address Social Determinants of Health (SDOH)

Extensive research and the pandemic have elevated the importance of addressing social determinants of health (SDOH) to improve health and reduce longstanding disparities in health and health care. Social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. This …

Medicaid Authorities and Options to Address Social Determinants of Health (SDOH) Read More »

Feds to Nix Work Requirements in Montana Medicaid Expansion Program

Federal health officials will likely reject Montana’s request to include work requirements for beneficiaries of its Medicaid expansion program, which insures 100,000 low-income Montana adults, state officials said. Three years after the Trump administration encouraged states to require proof that adult enrollees are working a certain number of hours or looking for work as a …

Feds to Nix Work Requirements in Montana Medicaid Expansion Program Read More »

Once Common, COVID-19 Deaths in Long-Term-Care Were Rare across Most States in June

Early in the COVID-19 pandemic, residents and staff at nursing homes and other long-term care facilities accounted for a huge share of COVID deaths, but a new KFF analysis finds that they were relatively rare events across the country in June. The analysis finds that 13 states and the District of Columbia in June reported…More

COVID-19 Cases and Deaths in Long-Term Care Facilities through June 2021

This data note examines state-level data on COVID-19 cases and deaths in long-term care facilities through June prior to the recent rise in cases and deaths nationally linked to the spread of the Delta variant. It finds long-term care deaths down 96% from their peak in December as the nation’s vaccination effort began.

KHN’s ‘What the Health?’: Hot Covid Summer

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. Predictions of a “hot vax summer” that would let Americans who had their covid immunizations celebrate the waning of the pandemic are turning out to have been …

KHN’s ‘What the Health?’: Hot Covid Summer Read More »

How a Doctor Breaks Norms to Treat Refugees and Recent Immigrants

AURORA, Colo. — Fatumo Osman, a 65-year-old Somali refugee who speaks limited English, was in a bind. She made too much money at a meal prep service job so she no longer qualified for Medicaid. But knee pain kept her from working, so her income had dropped. She could reapply for Medicaid, get her knee …

How a Doctor Breaks Norms to Treat Refugees and Recent Immigrants Read More »

Elimination of the Medicaid asset test?

No, this is not coming nation-wide, but it may be on its way in California. Kaiser Health News reports: A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people …

Elimination of the Medicaid asset test? Read More »

Despite Formidable Challenges, PACE Leaders Keep Expansion Dreams Alive

The Program of All-Inclusive Care for the Elderly (PACE) concept has gained significant business and policy momentum over the past several months, with recent research also highlighting just how successful programs were at avoiding COVID-19 deaths compared to other care settings. Despite that traction and the model’s clear benefits, PACE still faces a long list …

Despite Formidable Challenges, PACE Leaders Keep Expansion Dreams Alive Read More »

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP enrollment data through February 2021, as states were still in the early stages of the COVID-19 vaccine rollout and were experiencing some economic improvements compared to earlier in the pandemic. After declines in enrollment from 2017 through 2019, total Medicaid/CHIP enrollment grew to 81.0 …

Analysis of Recent National Trends in Medicaid and CHIP Enrollment Read More »

California Makes It Easier for Low-Income Residents to Get and Keep Free Health Coverage

SACRAMENTO, Calif. — Getting clean drinking water cost Ignacio Padilla his health insurance. The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He carefully socked away a few thousand dollars so he …

California Makes It Easier for Low-Income Residents to Get and Keep Free Health Coverage Read More »

How States Could Expand Medicaid HCBS Programs

A large chunk of the home-based care industry and its workforce is focused on the Better Care Better Jobs Act, a recently introduced piece of legislation that would pump billions of dollars into care for the elderly. Medicaid-reimbursed in-home care providers haven’t forgotten about the increased federal matching rate — or “FMAP” — for home- …

How States Could Expand Medicaid HCBS Programs Read More »

State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers

States are currently developing plans to access an increased federal matching rate (“FMAP”) for Medicaid HCBS spending established in the American Rescue Plan Act (ARPA) of 2021. In the future, states may also be able to access increased HCBS funds proposed in the Biden Administration’s American Jobs Plan and the Better Care Better Jobs Act …

State Options to Expand Medicaid HCBS: Examples & Evaluations of Section 1115 Waivers Read More »

Senate Democrats’ Plan Boosts Spending on Medicare, ACA Subsidies, Long-Term Care

The budget package Democrats are assembling in Congress would likely provide the biggest jolt to the American health care system since the passage of the Affordable Care Act in 2010, according to sources familiar with work on the plan. Democrats in the Senate announced Tuesday night that they had reached a framework for a $3.5 …

Senate Democrats’ Plan Boosts Spending on Medicare, ACA Subsidies, Long-Term Care Read More »

How do claim denials affect physician willingness to accept Medicaid patients?

From a recent article in NBER by Dunn et al. (2021): Observing the back-and-forth sequences of claims’ denials and resubmissions for past visits, we can estimate physicians’ costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 17% of Medicaid revenue to billing problems, …

How do claim denials affect physician willingness to accept Medicaid patients? Read More »

KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Biden administration stands ready to work with Congress to address drug prices and expand Medicare, Health and Human Services Secretary Xavier Becerra said in a wide-ranging …

KHN’s ‘What the Health?’: Becerra Urges Congress to Expand Medicare, Address Rx Prices Read More »

Transactions: Amedisys acquires VNA’s Home Health Assets; AccordCare Expands Medicaid Business

Amedisys Inc. (Nasdaq: AMED) has completed its purchase of Visiting Nurse Association’s (VNA) assets. Baton Rouge, Louisiana-based Amedisys has a number of in-home care capabilities, including home health, hospice and personal care services. Amedisys also recently acquired Contessa Health for $250 million. The deal gives the company a range of acute-level care services. Meanwhile, VNA …

Transactions: Amedisys acquires VNA’s Home Health Assets; AccordCare Expands Medicaid Business Read More »

ConcertoCare Adds Chief People Officer; CMS Appoints Medicaid Director

ConcertoCare appoints chief people officer ConcertoCare has hired Rachel Grace as its chief people officer. Backed by Deerfield Management Company, the Aliso Viejo, California-based ConcertoCare offers in-home primary care, virtual care and PACE services to dual-eligible seniors and those enrolled under Medicare Advantage. In her new role, Grace will be responsible for developing hiring and …

ConcertoCare Adds Chief People Officer; CMS Appoints Medicaid Director Read More »

A Family Wellness Check: California Invests in Treating Parents and Children Together

When a parent takes an infant to the Children’s Health Center in San Francisco for a routine checkup, a pediatrician will check the baby’s vitals and ask how the child is doing at home. Then Janelle Bercun, a licensed clinical social worker, who is also in the room, will look at Mom or Dad and …

A Family Wellness Check: California Invests in Treating Parents and Children Together Read More »

Cano Health buys Doctor’s Medical Center for $300M

Senior-focused primary care provider Cano Health acquired Doctor’s Medical Center for $300 million, which adds around 54,000 new members and 18 medical centers to its roster. This is the second major acquisition for Cano Health in less than a month. The company bought University Health Care for $600 million in mid-June.

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess.

A colonoscopy might cost you or your insurer a few hundred dollars — or several thousand, depending on which hospital or insurer you use. Long hidden, such price variations are supposed to be available in stark black and white under a Trump administration price transparency rule that took effect at the start of this year. …

Hospital Prices Must Now Be Transparent. For Many Consumers, They’re Still Anyone’s Guess. Read More »

Job losses, federal regulations drove Medicaid enrollment to a historic high

Enrollment in Medicaid and the Children’s Health Insurance Program has reached a record high, with 80 million now covered through these programs. The spike was largely driven by the economic downturn brought on by the pandemic and a federal requirement that prevents states from removing people from the programs until the public health crisis is …

Job losses, federal regulations drove Medicaid enrollment to a historic high Read More »

KHN’s ‘What the Health?’: Un-Trumping the ACA

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Biden administration this week proposed a series of changes aimed at boosting insurance enrollment under the Affordable Care Act, undoing changes made by the Trump administration …

KHN’s ‘What the Health?’: Un-Trumping the ACA Read More »

Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply

CASTINE, Maine — For years, Louise Shackett has had trouble walking or standing for long periods, making it difficult for her to clean her house in southeastern Maine or do laundry. Shackett, 80, no longer drives, which makes it hard to get to the grocery store or doctor. Her low income, though, qualifies her for …

Desperate for Home Care, Seniors Often Wait Months With Workers in Short Supply Read More »

‘Choose Home’ Legislation Gaining Significant Support in Congress, Nearing Formal Introduction

“Choose Home,” major legislation designed to help more people age in place, is gaining momentum on Capitol Hill. There’s even a chance a Choose Home bill is introduced before Congress’s July 4 recess. That’s according to National Association for Home Care & Hospice (NAHC) President Bill Dombi. If introduced and eventually enacted, Choose Home would …

‘Choose Home’ Legislation Gaining Significant Support in Congress, Nearing Formal Introduction Read More »

Pandemia eleva el número de beneficiarios de Medicaid a más de 80 millones

Las últimas cifras de inscripción al Medicaid muestran que creció de 71,3 millones de miembros en febrero de 2020, cuando la pandemia comenzaba en los Estados Unidos, a 80,5 millones en enero, según un análisis de KFF de datos federales. La recesión causada por la pandemia y un requisito federal de que los estados mantuvieran …

Pandemia eleva el número de beneficiarios de Medicaid a más de 80 millones Read More »

Pandemic Swells Medicaid Enrollment to Record 80 Million People

The pandemic-caused recession and a federal requirement that states keep Medicaid beneficiaries enrolled until the national emergency ends swelled the pool of people in the program by more than 9 million over the past year, according to a report released Thursday. The latest figures show Medicaid enrollment grew from 71.3 million in February 2020, when …

Pandemic Swells Medicaid Enrollment to Record 80 Million People Read More »

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP enrollment data through January 2021, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data show that total enrollment grew to 80.5 million in January …

Analysis of Recent National Trends in Medicaid and CHIP Enrollment Read More »

GuideWell Announces Strategic Investment in Home-Based Primary Care Provider PopHealthCare

Health plans — and the entities that own them — continue to invest heavily around in-home care. The latest example is GuideWell Mutual Holding Corporation, which announced a new “multi-year strategic investment” in subsidiary PopHealthCare on Wednesday. The company is not disclosing the exact size of the investment. “At GuideWell, we are committed to transforming …

GuideWell Announces Strategic Investment in Home-Based Primary Care Provider PopHealthCare Read More »

How Do CMS’s New COVID-19 Vaccine Reporting and Education Rules Apply To Different Long-Term Care Settings?

Recognizing that ongoing vaccination efforts are crucial to ending the pandemic, CMS issued an Interim Final Rule with Comment Period (IFC) that establishes new vaccine reporting and/or education requirements for nursing homes and ICF/IDDs as of May 21st, 2021. Public comments are due July 12, 2021, after which CMS may revise the rule.

KHN’s ‘What the Health?’: Our 200th Episode!

Can’t see the audio player? Click here to listen on SoundCloud. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts. The Food and Drug Administration found itself in the hot seat this week when it approved a controversial new drug to treat Alzheimer’s disease with scant evidence …

KHN’s ‘What the Health?’: Our 200th Episode! Read More »

Zooming Into the Statehouse: Nursing Home Residents Use New Digital Skills to Push for Changes

Patty Bausch isn’t a Medicaid expert, lawyer or medical professional. But she still thinks Connecticut legislators need her input when they consider bills affecting people like her — the roughly 18,000 residents who live in the state’s nursing homes. With help and encouragement from Connecticut’s Long Term Care Ombudsman Program, Bausch signed up and testified …

Zooming Into the Statehouse: Nursing Home Residents Use New Digital Skills to Push for Changes Read More »

Study: Poor care access, higher costs more likely with private than public insurance

People with private insurance report poorer access to care, higher costs and lower satisfaction as compared to those with public insurance plans, a new study shows. As the debate over health insurance reform continues, policymakers should consider efforts that expand Medicare and increase protections for those with private insurance.

Supplemental Security Income for People with Disabilities: Implications for Medicaid

This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn as well as proposals supported by President Biden that Congress might consider.

Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief

The new head of the federal agency that oversees health benefits for nearly 150 million Americans and $1 trillion in federal spending said in one of her first interviews that her top priorities will be broadening insurance coverage and ensuring health equity. Use Our Content It can be republished for free. “We’ve seen through the …

Expanding Insurance Coverage Is Top Priority for New Medicare-Medicaid Chief Read More »

Many New Moms Get Kicked Off Medicaid 2 Months After Giving Birth. Illinois Will Change That.

The U.S. is the only industrialized nation in which the maternal death rate has been rising. Each year, about 700 deaths are due to pregnancy, childbirth or subsequent complications, according to the Centers for Disease Control and Prevention. This story also ran on NPR. It can be republished for free. When someone dies while pregnant or within a …

Many New Moms Get Kicked Off Medicaid 2 Months After Giving Birth. Illinois Will Change That. Read More »

Newsom Wants to Spend Millions on the Health of Low-Income Mothers and Their Babies

Amid a pandemic that has pushed millions of mothers out of the workplace, caused fertility rates to plunge and heightened the risk of death for pregnant women, California Gov. Gavin Newsom and Democratic lawmakers are seeking a slate of health proposals for low-income families and children. Newsom, a self-described feminist and the father of four …

Newsom Wants to Spend Millions on the Health of Low-Income Mothers and Their Babies Read More »

Addus Focused on Sourcing New Home Health Acquisitions, Improving Applicant-Conversion Rates

The COVID-19 public health emergency has solidified the home as a viable and effective care setting. That, in turn, has led to meaningful opportunities for home-based care providers, especially those with diversified service lines. Addus HomeCare Corporation (Nasdaq: ADUS) is a prime example. The company’s leadership team discussed the pandemic and its lasting impacts during …

Addus Focused on Sourcing New Home Health Acquisitions, Improving Applicant-Conversion Rates Read More »

Caring for an Aging Nation

USE OUR CONTENT This story can republished for free. Please contact KHNweb@kff.org for embed codes. Table of Contents A Variety of Services Booming Number of Seniors The Cost of Long-Term Care Services The Physical – and Financial – Burden The $61 Billion Price Tag Health care for the nation’s seniors looms large as the baby-boom …

Caring for an Aging Nation Read More »

Colorado Will Pay Hospitals to Close Expensive Free-Standing ERs

Colorado health officials so abhor the high costs associated with free-standing emergency rooms they’re offering to pay hospitals to shut the facilities down. This story also ran on Fortune. It can be republished for free. The state wants hospitals to convert them to other purposes, such as providing primary care or mental health services. At …

Colorado Will Pay Hospitals to Close Expensive Free-Standing ERs Read More »

American Rescue Plan Funding Starts to Trickle Down to States, HCBS Programs

American Rescue Plan (ARP) funding has started trickling down to programs aimed at helping seniors age in place. Earlier in May, the Biden administration released $1.4 billion for Older American Act-enabled initiatives related to vaccine coordination, senior nutrition and more. Meanwhile, the U.S. Department of the Treasury has been overseeing the distribution of $350 billion …

American Rescue Plan Funding Starts to Trickle Down to States, HCBS Programs Read More »

KHN’s ‘What the Health?’: Roe v. Wade on the Ropes

Can’t see the audio player? Click here to listen on SoundCloud. The Supreme Court agreed to hear a case next term that could result in a significant modification or overturn of Roe v. Wade, the 1973 case that legalized abortion nationwide. At issue is a Mississippi law that would ban the procedure after 15 weeks of …

KHN’s ‘What the Health?’: Roe v. Wade on the Ropes Read More »

Why Your Dentist Might Seem Pushy

In 1993, Dr. David Silber, a dentist now practicing in Plano, Texas, was fired from the first dental clinic he worked for. He’d been assigned to a patient another dentist had scheduled for a crown preparation — a metal or porcelain cap for a broken or decayed tooth. However, Silber found nothing wrong with the …

Why Your Dentist Might Seem Pushy Read More »

Report: Payers saw higher gross margins, lower loss ratios in 2020, indicating profitability

Payers appeared to have a profitable 2020, with gross margins per member per month increasing, and administrative costs and medical loss ratios decreasing, a new report shows. But payers still have to contend with rebates their owe per the ACA medical loss ratio provision, which could amount to more than $2 billion.

The Pandemic Has Exacerbated Long-Standing Health Care Challenges Faced By Puerto Rico and Other U.S. Territories as the End of Temporary Federal Medicaid Funding Approaches

A new KFF analysis examines how the coronavirus pandemic is affecting U.S. territories as well as issues related to the upcoming expiration of temporary Medicaid funding for the territories at the end of September. Prior to the pandemic, the U.S territories –– American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico,…More

Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff

More than a year into the public health emergency, the COVID-19 pandemic continues to impact the lives of Americans including those living in the U.S. territories. Differences in Medicaid financing, including a statutory cap and match rate, have contributed to broader fiscal and health systems challenges for the territories. While additional federal funds have been …

Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff Read More »

Texas lawsuit: Biden administration threatening funding to force Medicaid expansion

Filed by the Texas attorney general, a new lawsuit seeks to prevent the Biden administration from revoking the Trump-era approval of a Medicaid waiver extension that could cost the state billions in funds. The revocation was a political move intended to force the state to expand Medicaid under the ACA, the lawsuit claims.

You’ve Added Your Kids to Your Health Plan. What About Mom?

SACRAMENTO — When Laura Chavez’s 74-year-old mom needed eye surgery last month, Chavez paid cash for the procedure. This story also ran on Los Angeles Times. It can be republished for free. The cost? $15,000 — and that was for just one eye. She couldn’t afford both. Her mom, Esperanza Chavez, doesn’t qualify for Medicare …

You’ve Added Your Kids to Your Health Plan. What About Mom? Read More »

InnovAge CEO: ‘We Have a Couple of Irons in the Fire’

Even though InnovAge (Nasdaq: INNV) is already one of the largest Program of All-Inclusive Care for Elderly (PACE) providers in the U.S., the company has plans to go after an even bigger piece of the pie. Maureen Hewitt, president and CEO of InnovAge, talked about the company’s multi-pronged growth strategy on Monday during a conference …

InnovAge CEO: ‘We Have a Couple of Irons in the Fire’ Read More »

This Mother’s Day, Let’s Get Mothers the Health Care Coverage They Need

Mothers deserve more than a day of recognition this year—they deserve the whole month, and more. The pandemic has been particularly hard on women, especially poor women and women of color.  To demonstrate the appreciation mothers deserve this Mother’s Day, we should get them something they really need: health care. To improve maternal health, we should look …

This Mother’s Day, Let’s Get Mothers the Health Care Coverage They Need Read More »

Medicaid and State Financing: Key Indicators to Watch Through Pandemic and Recovery

The health and economic effects of the pandemic have significant implications for state Medicaid programs. More people become eligible and enroll in Medicaid during economic downturns; at the same time, states may face declines in revenues. This brief presents the most current data for key indicators to help understand how various economic factors that could …

Medicaid and State Financing: Key Indicators to Watch Through Pandemic and Recovery Read More »

5 Things to Know About Health Care Changes in Montana

HELENA, Mont. — The 2021 Montana legislative session will be remembered as one of the state’s most consequential as a Republican-led legislature and governor’s office passed new laws restricting abortions, lowering taxes and regulating marijuana. Use Our Content It can be republished for free. But the debate over those and other highly publicized issues may …

5 Things to Know About Health Care Changes in Montana Read More »

New Analysis Summarizes Recent Research on the Effects of ACA Medicaid Expansion, Providing Context for Renewed Expansion Debates in States

New federal financial incentives for Medicaid expansion and the increased reliance on Medicaid as a coverage safety net during the pandemic have renewed debate in the 12 states that have not adopted the Medicaid expansion under the Affordable Care Act. A new KFF literature review provides context for these expansion debates by summarizing evidence from…More

Potential Implications of Policy Changes in Medicaid Drug Purchasing

This brief examines how leading federal and state policy options related to changes in Medicaid Drug Rebate Program (MDRP), drug pricing, and payment and management of the Medicaid prescription drug would affect state and federal governments as well as private industry (including drug manufacturers, managed care organizations, and pharmacies).

Covered California Says Health Insurance Just Got Too Cheap to Ignore

If you are uninsured because health coverage seemed too expensive the last time you looked, it’s time to look again. Use Our Content It can be republished for free. A new federal law could make it a whole lot cheaper to buy your own insurance if you don’t get coverage through an employer or a …

Covered California Says Health Insurance Just Got Too Cheap to Ignore Read More »

Health Insurer Financial Performance in 2020

This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, suggesting many insurers remained profitable even as health spending rebounded and COVID-19 cases surged in the fall and winter.

In Speech to Congress, President Biden Again Shines Spotlight on Home-Based Care

In a speech delivered to Congress Wednesday, President Joe Biden again mentioned the importance of providing care to seniors in their own homes. Specifically, he touted his administration’s previously announced American Jobs Plan, which would include $400 billion for home-based care. Much of that money would go to the workforce, with home health and home …

In Speech to Congress, President Biden Again Shines Spotlight on Home-Based Care Read More »

KHN’s ‘What the Health?’: 100 Days of Health Policy

Can’t see the audio player? Click here to listen on SoundCloud. It’s been a busy 100 days for the Biden administration on health policy. The promise Joe Biden made as president-elect to get 100 million covid vaccinations in arms was doubled, healthcare.gov reopened to those without insurance, and steps were taken to undo a raft of …

KHN’s ‘What the Health?’: 100 Days of Health Policy Read More »

Votive Health Raises $2.5M to Help Home-Based Care Providers Make Value-Based Arrangements

Votive Health — a technology startup that facilitates payer-provider integration — formally announced its launch and first funding round on Wednesday. The company raked in $2.5 million in a round led by Flare Capital Partners, with Chrysalis Ventures and OCA Ventures as co-investors. San Luis Obispo, California-based Votive Health is a technology-enabled network manager that …

Votive Health Raises $2.5M to Help Home-Based Care Providers Make Value-Based Arrangements Read More »

COVID-19 Deaths and Cases in Long-Term Care Facilities Have Fallen to All-Time Lows in the Four Months Since Vaccinations Began

COVID-19 deaths and cases among residents and staff of long-term care facilities have fallen dramatically since vaccinations began in December, with deaths declining by nearly 89 percent and cases declining by nearly 92 percent as of April 2021, according to a new KFF analysis. COVID-19 deaths in long-term care settings fell from 1.7 deaths per…More

COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern

This data note looks at state-reported LTCF data from 41 states plus Washington DC to assess what has happened to new deaths and cases in LTCFs in the four months since vaccinations began on December 21st, 2020. We also examine how recent changes in deaths and cases in LTCFs have shifted the nature of the …

COVID-19 Long-Term Care Deaths and Cases Are at An All-Time Low, Though A Rise In LTC Cases In A Few States May Be Cause for Concern Read More »

What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?

A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s “coverage gap,” including providing further new incentives for states to expand Medicaid, creating a new “public option” or extending ACA Marketplace premium subsidies to low-income people who don’t currently qualify for federal help. At stake is affordable…More

KHN’s ‘What the Health?’: Picking Up the Pace of Undoing Trump Policies

Can’t see the audio player? Click here to listen on SoundCloud. The Biden administration is speeding up the pace of efforts to undo Trump administration health policies. The two most recent: overturning a ban on fetal tissue research funded by the National Institutes of Health and canceling a last-minute extension of a Medicaid waiver for Texas. …

KHN’s ‘What the Health?’: Picking Up the Pace of Undoing Trump Policies Read More »

Why Minnesota’s Largest Home Care Provider Doubled Down on Financial Management Services

In the crowded home-based care market, providers have been forced to become increasingly more creative when it comes to their service offerings. One company, Accra, recently saw success with the growth of its unique financial management services program. The Minnetonka-based Accra is the largest provider of home care services in Minnesota. Among its offerings, the …

Why Minnesota’s Largest Home Care Provider Doubled Down on Financial Management Services Read More »

Strides Against HIV/AIDS Falter, Especially in the South, as Nation Battles Covid

Facing a yearlong siege from the coronavirus, the defenses in another, older war are faltering. This story also ran on NPR. It can be republished for free. For the last two decades, HIV/AIDS has been held at bay by potent antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic has caused …

Strides Against HIV/AIDS Falter, Especially in the South, as Nation Battles Covid Read More »

KHN’s ‘What the Health?’: Pause and Effect on Covid Vaccines

Can’t see the audio player? Click here to listen on SoundCloud. The effort to vaccinate Americans against covid-19 took a hit this week. The Centers for Disease Control and Prevention and the Food and Drug Administration jointly called for a pause in use of the vaccine made by Johnson & Johnson while experts try to figure …

KHN’s ‘What the Health?’: Pause and Effect on Covid Vaccines Read More »

Biden, Congress Extend Medicare Sequestration Holiday Through 2021

The long and winding saga behind the Medicare sequestration holiday for home health providers and others has come to a close. On Tuesday, the U.S. House of Representatives overwhelmingly voted by a 384-38 margin in favor of a continued sequestration delay. The legislation was one of two measures introduced since early March aimed at delaying …

Biden, Congress Extend Medicare Sequestration Holiday Through 2021 Read More »

What Will It Take for Hospitals to Survive the Pandemic?

Dr. John Frownfelter, MD, FACP, Chief Medical Officer at Jvion In 1852, Mercy Hospital & Medical Center opened as Chicago’s first chartered hospital. In May, it will close, leaving residents of the surrounding South Side community — poor and mostly people of color — without a place to see a doctor. And it isn’t the …

What Will It Take for Hospitals to Survive the Pandemic? Read More »

Illinois first state to offer full Medicaid benefits to women one year postpartum 

As part of its ongoing effort to improve maternal outcomes in the country, the government has approved Illinois’ request to extend full Medicaid coverage for new mothers. The approval extends the coverage from 60 days to one year and will give about 2,500 women living below the poverty line access to care every year.

‘There Is Not An Easy Solution’: How to Modernize Home- and Community-Based Services

Home-based care insiders have been saying for a long time what a wider group of people are now: Care needs to be brought into the home more frequently — and quickly. But accomplishing that won’t be so simple. In fact, turning the nation’s long-term care system into one that allows more seniors to age in …

‘There Is Not An Easy Solution’: How to Modernize Home- and Community-Based Services Read More »

Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake.

There’s widespread agreement that it’s important to help older adults and people with disabilities remain independent as long as possible. But are we prepared to do what’s necessary, as a nation, to make this possible? This story also ran on NPR. It can be republished for free. That’s the challenge President Joe Biden has put …

Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake. Read More »

Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy

Jessica Scruton, BSN, RN, CCM, VP of Clinical Transformation for Lightbeam Health Solutions COVID-19 forced many health systems to reassess and reconfigure their care management processes and staffing models so that clinicians could better manage more of their acute, complex, and otherwise healthy patients remotely to limit in-person care.  During this time, health systems likely …

Time and Goals Should Drive Your Post-COVID-19 Care Management Strategy Read More »

KHN’s ‘What the Health?’: Health Care as Infrastructure

Can’t see the audio player? Click here to listen on SoundCloud. Health care makes some surprising appearances in President Joe Biden’s $2 trillion infrastructure plan, even though more health proposals are expected in a second proposal later this month. The bill that would help rebuild roads, bridges and broadband capabilities also includes $400 billion to help …

KHN’s ‘What the Health?’: Health Care as Infrastructure Read More »

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP enrollment data through November 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data show that total enrollment grew to 78.9 million in November, …

Analysis of Recent National Trends in Medicaid and CHIP Enrollment Read More »

Centene refutes Ohio AG’s lawsuit, says it reflects misunderstanding of Medicaid billing

Centene has rebutted the accusations made in a sealed lawsuit filed by the Ohio attorney general that accused the insurer of over-billing the state’s Medicaid department. The lawsuit is based on a misunderstanding of how Medicaid billing operates and should be unsealed, Centene said.

‘There Are Still Many Questions Unanswered’: Home Care Providers Seek Clarity on American Rescue Plan

As part of the recently passed $1.9 trillion American Rescue Plan, state Medicaid programs have seemingly received a major bump in funding for vital home- and community-based services (HCBS). In theory, the bump is designed to help HCBS operators expand their services, attract new workers and take on more clients. Still, some in-home care providers …

‘There Are Still Many Questions Unanswered’: Home Care Providers Seek Clarity on American Rescue Plan Read More »

Missouri ‘Voted for This Lie,’ Says State Rep Trying to Block Medicaid Expansion

It is hard to qualify for Medicaid as an adult in Missouri. Single adults aren’t eligible for coverage through the state’s program — dubbed MO HealthNet — at all, and parents can’t make more than 21% of the federal poverty level: $5,400 in 2021 for a family of three. This story is part of a …

Missouri ‘Voted for This Lie,’ Says State Rep Trying to Block Medicaid Expansion Read More »

Families With Sick Kids on Medicaid Seek Easier Access to Out-of-State Hospitals

Three-year-old Elizabeth Zakutansky was born with a rare genetic condition that causes multiple seizures. Her neurologist, a top expert on treating her condition, practices at Lurie Children’s Hospital of Chicago, less than an hour’s drive from the Zakutanskys’ home in Hobart, Indiana. Her parents would like her to get all her care there. This story …

Families With Sick Kids on Medicaid Seek Easier Access to Out-of-State Hospitals Read More »

KHN’s ‘What the Health?’: Planning for Round Two

Can’t see the audio player? Click here to listen on SoundCloud. Congress is out of session, but that hasn’t stopped Democrats from planning their next round of health legislation. Together with President Joe Biden, they are looking at a broad array of possibilities, from allowing Medicare to negotiate drug prices to adding more benefits to the …

KHN’s ‘What the Health?’: Planning for Round Two Read More »

Boost Operational, Clinical and Financial Performance with Good Data

Peter Nelson, VP & General Manager, Global Alliances at GHX There’s an old adage that every challenge is merely an opportunity in disguise. COVID-19 highlighted the healthcare industry’s ongoing challenge with producing clean, standardized data. As the industry looks to rebound from the severe financial impact of the pandemic, there’s a renewed urgency among hospitals …

Boost Operational, Clinical and Financial Performance with Good Data Read More »

Indiana’s Medicaid Expansion — Designed by Pence and Verma — Panned in Federal Report

Indiana’s Medicaid expansion — with its “personal responsibility” provisions that require enrollees to pay monthly premiums and manage health savings accounts — proved no better at improving health and access to care than other state expansions, a federally commissioned study found. Use Our Content It can be republished for free. Even when compared with states …

Indiana’s Medicaid Expansion — Designed by Pence and Verma — Panned in Federal Report Read More »

‘A Monumental Advance’: Newly Unveiled American Jobs Plan Would Invest $400B into Home-Based Care

President Joe Biden is trying to make good on one of his main campaign promises. The Biden administration on Wednesday unveiled a new $2 trillion infrastructure proposal to create jobs, build roads, fix bridges and more. On top of that, the proposal — officially dubbed the American Jobs Plan — would substantially increase funding for …

‘A Monumental Advance’: Newly Unveiled American Jobs Plan Would Invest $400B into Home-Based Care Read More »

Cityblock nets another $192M, plans to expand into maternity and pediatrics

The startup, which provides primary care services to Medicaid patients, plans to use the funds to expand into new states and add maternity and pediatrics services lines. It also recently launched a vaccination site in conjunction with the New York Department of Health.

The Great Undoing: Which of Trump’s Policies Will Biden Reverse?

KHN has put together an interactive tool of significant health policies implemented by the Trump administration using its own authority — executive orders, agency guidance or formal regulations — and is tracking Biden administration and court actions. We will update this chart as actions are taken. Topics: Affordable Care Act | HHS Operations | Immigration …

The Great Undoing: Which of Trump’s Policies Will Biden Reverse? Read More »

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models

Mark Prather MD, MBA, CEO & Co-founder at DispatchHealth The COVID-19 pandemic has transformed how we interact with one another, with businesses, and with the world around us. From social distancing to hand sanitation to remote working, its impact on society is immense. And among the various industries that are experiencing significant change as a …

How the Pandemic is Accelerating the Shift to Alternative Care Delivery Models Read More »

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap.

When Democrats pushed through a two-year expansion of the Affordable Care Act in the covid-relief bill this month, many people celebrated the part that will make health insurance more affordable for more Americans. This story also ran on NPR. It can be republished for free. But health care researchers consider this move a short-term fix …

Democrats Gave Americans a Big Boost Buying Health Insurance. It Didn’t Come Cheap. Read More »

KHN’s ‘What the Health?’: ACA Packs More Benefits — And More Confusion

Can’t see the audio player? Click here to listen on SoundCloud. The covid relief bill signed by President Joe Biden a week ago includes billions of dollars in new health benefits for consumers. But those benefits may be hard for people to take advantage of because of the interaction with the income tax system and the …

KHN’s ‘What the Health?’: ACA Packs More Benefits — And More Confusion Read More »

SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups

An innovative care concept designed to keep patients at home and out of skilled nursing facilities (SNFs) is reportedly gaining ground in Congress and among special interest groups. The concept — known as “Choose Home” — is a type of SNF-at-home model that leverages both medical and non-medical home care services for certain patients. LHC …

SNF-at-Home Concept Earning ‘Very Positive Feedback’ in Congress, Among Special Interest Groups Read More »

Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health

What You Should Know: –   Unite Us, the tech company creating coordinated care networks nationwide, has just announced a $150M Series C round of funding led by ICONIQ Capital, bringing its valuation at $1.65 billion.   – Unite Us is leading the care transformation movement towards whole-person health with its core product, Unite Us Platform, an outcome-focused coordination software sconnecting community-based …

Unite Us Nabs $150M, Reaching $1.6B Valuation to Address Social Determinants of Health Read More »

Analysis: The Trump Health Care Policies That Deserve to Stick Around

President Joe Biden’s goal of providing health care for more Americans advanced this week with his signing of an economic stimulus package that includes subsidies for health insurance premiums and new incentives for states to expand Medicaid, as well as the potential confirmation of Xavier Becerra as secretary of Health and Human Services. This story …

Analysis: The Trump Health Care Policies That Deserve to Stick Around Read More »

Quality Virtual Care Matters for Patients – Even More Than Telehealth

Rick Halton, Vice President of Marketing, Lumeon The COVID-19 pandemic made healthcare visits over video or phone the norm, likely turning telehealth into a permanent fixture within the U.S. healthcare system. In fact, the majority of patient access leaders at large hospitals believe 20-30 percent of appointments will happen over video in 2021, according to …

Quality Virtual Care Matters for Patients – Even More Than Telehealth Read More »

Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities

The American Rescue Plan includes a provision to increase the federal matching rate (FMAP) for spending on Medicaid HCBS by 10 percentage points from April 1, 2021 through March 31, 2022 provided states maintain state spending levels as of April 1, 2021.This brief discusses the proposal and provides state by state estimates of the potential …

Potential Impact of Additional Federal Funds for Medicaid HCBS for Seniors and People with Disabilities Read More »

Centene’s “corporate greed” led it to allegedly overcharge Ohio’s Medicaid department

The Ohio attorney general has filed a lawsuit alleging that a Centene subsidiary, which provides Medicaid services in the state, hired multiple companies to administer pharmacy benefits in order to inflate costs. As a result, the state’s Medicaid department paid millions in overcharges.

PE-Backed Help at Home Names New CEO

Help at Home has a new CEO. The home- and community-based services provider announced Monday that current board member Chris Hocevar has been appointed chief executive officer, effective immediately. Hocevar replaces Paul Mastrapa, who previously served as a consultant and as the leader of Option Care before taking over as Help at Home’s CEO in …

PE-Backed Help at Home Names New CEO Read More »

Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022

Even as the COVID-19 vaccine roll-out is accelerating across the country, the public health and economic effects of the pandemic continue to put pressure on Medicaid spending and enrollment. In mid-February 2021, the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) fielded a two-part rapid, mini-survey of Medicaid directors in all 50 states and …

Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022 Read More »

A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out

As of February 2021, there are three COVID-19 vaccines approved for emergency use in the U.S. and states are playing a central role in their timely distribution and prioritizing eligible populations. Because Medicaid covers for over 77 million enrollees, including groups disproportionately at risk of contracting COVID-19 as well as hard-to-reach groups, Medicaid agencies can …

A Look at How Medicaid Agencies Are Assisting with the COVID-19 Vaccine Roll-Out Read More »

KHN’s ‘What the Health?’: Expanding the ACA in an Unpredicted Way

Can’t see the audio player? Click here to listen on SoundCloud. For the first time since its enactment in 2010, the Affordable Care Act is slated for major benefit expansions, courtesy of the covid relief bill approved by Congress this week. But the changes are only temporary, so the measure also tees up a fight to …

KHN’s ‘What the Health?’: Expanding the ACA in an Unpredicted Way Read More »

Addus Enters Value-Based Care Deal with Presbyterian Health Plan

Addus HomeCare Corporation (Nasdaq: ADUS) — the personal care services powerhouse that has increasingly turned its attention to home health and hospice care over the past few years — has inked a new value-based care deal. The Frisco, Texas-based in-home care company announced Wednesday that it has entered into a “value-based post-acute care navigation agreement” …

Addus Enters Value-Based Care Deal with Presbyterian Health Plan Read More »

Early COVID-19 Vaccination Efforts Through Community Health Centers Are Reaching People of Color

More than half of those who received their first dose of a COVID-19 vaccine through a community health center were people of color, suggesting that health centers appear to be doing a better job of reaching people of color than are overall vaccination efforts, finds a new KFF analysis. People of color accounted for 54 percent…More

Meet Circulo, the insurtech firm on a mission to disrupt Medicaid managed care

A new startup has entered the highly competitive insurtech market — with $50 million in new funds. Circulo, co-founded by Olive CEO Sean Lane, is a Medicaid managed care company that plans to build a platform to improve care delivery and member experience.

KFF Tracking Poll: More Than a Third of Americans Say They’ve Struggled to Pay Living Expenses Since December; 6 in 10 Families Hit by COVID Have Lost A Job or Income

Majorities Favor Provisions to Expand Marketplace Tax Credits and Encourage States to Expand Medicaid As Congress considers an additional $1.9 trillion COVID-19 relief plan, more than a third (37%) of Americans say that someone in their household has had trouble paying basic living expenses over the past three months, the latest KFF Health Tracking Poll…More

KFF Health Tracking Poll: Economic Hardship, Health Coverage, And The ACA

This poll examines the public’s assessments of the Biden administration’s handling of the coronavirus pandemic, the impact COVID-19 has had on people’s finances, and support for provisions of the latest COVID-19 relief bill. It examines the public’s views of the ACA and possible next steps.

Many Nonelderly People With Disabilities Face COVID-19 Risks Similar to Those of the Elderly in Nursing Homes, But Do Not Have Equal Footing When it Comes to Vaccine Priority

While the toll of COVID-19 on nursing home residents has been well documented, less noticed has been the experience of nonelderly people with disabilities who rely on long-term care services and supports outside of nursing homes. In many ways the two groups face similar health risks from the virus, but nonelderly people with disabilities generally…More

COVID-19 Vaccine Access for People with Disabilities

This issue brief presents current state-level data about COVID-19 cases and deaths in settings that primarily serve nonelderly people with disabilities and summarizes available research on this population’s elevated risk of severe illness and death; explains how nonelderly people with disabilities and their LTSS providers are reflected in state vaccine prioritization plans; and discusses key …

COVID-19 Vaccine Access for People with Disabilities Read More »

State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates

This brief takes a closer look at multiple measures beyond waiver waiting lists to evaluate state choices about optional Medicaid eligibility pathways, spending, and services for seniors and people with disabilities as of 2018. The analysis draws on several KFF resources, including 50-state surveys of Medicaid financial eligibility pathways for seniors and people with disabilities, …

State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates Read More »

OBGYNs and the Provision of Sexual and Reproductive Health Care: Key Findings from a National Survey

This report highlights key findings from the 2020 KFF National Physician Survey on Reproductive Health that asked a nationally representative sample of OBGYNs practicing in the United States about a wide range of issues, including their provision of contraception, abortion, and STI care.

With GOP Back at Helm, Montana Renews Push to Sniff Out Welfare Fraud

Montana is considering becoming the latest state to intensify its hunt for welfare overpayments and fraud, a move expected to remove more than 1,500 enrollees from low-income health coverage at a time when the pandemic has left more people needing help. With Republicans now controlling both chambers of the Montana legislature and the governor’s office, …

With GOP Back at Helm, Montana Renews Push to Sniff Out Welfare Fraud Read More »

3 Ways to Boost Patient Confidence with Real-Time Contactless Communication

Ford Blakely, SVP & GM, Medallia Zingle Although the vaccine’s rollout is slowly underway, Covid cases worldwide are continuing to reach all-time highs as new mutations make the virus even more contagious than ever before. Not surprisingly, patients’ concerns about visiting their healthcare providers in the midst of this global pandemic persist, pushing demand for …

3 Ways to Boost Patient Confidence with Real-Time Contactless Communication Read More »

KHN’s ‘What the Health?’: Open Enrollment, One More Time

Can’t see the audio player? Click here to listen on SoundCloud. An estimated 9 million Americans eligible for free or reduced premium health insurance under the Affordable Care Act have a second chance to sign up for 2021 coverage, since the Biden administration reopened enrollment on healthcare.gov and states that run their own marketplaces followed suit. …

KHN’s ‘What the Health?’: Open Enrollment, One More Time Read More »

Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs

The House COVID-19 relief proposal would temporarily lower what millions of Marketplace enrollees and uninsured potential enrollees would pay toward premiums and would provide states that have not expanded their Medicaid programs a financial boost that would more than offset their costs initially, two new KFF analyses find. The analyses assess two parts of the…More

New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending

The House Energy and Commerce Committee reconciliation proposal as part of the COVID relief package aims to encourage non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. This brief provides illustrative estimates of the net fiscal benefit to states from these …

New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending Read More »

Arizona to Implement a Statewide Social Determinants of Health Closed Loop Referral System

What You Should Know: – Health Current, Arizona’s health information exchange (HIE), today announced the selection of NowPow as the vendor of choice for Arizona’s closed-loop referral system (CLRS) to address social determinants of health (SDOH) needs in Arizona. – By connecting healthcare and community service providers on a single statewide technology platform, this new …

Arizona to Implement a Statewide Social Determinants of Health Closed Loop Referral System Read More »

Why Biden Has a Chance to Cut Deals With Red State Holdouts on Medicaid

President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade. The opportunity emerges as the covid-19 pandemic saps state budgets and strains …

Why Biden Has a Chance to Cut Deals With Red State Holdouts on Medicaid Read More »

KHN’s ‘What the Health?’: All About Budget Reconciliation

Can’t see the audio player? Click here to listen on SoundCloud. President Joe Biden has said he still wants a bipartisan bill to provide the next round of covid relief. But in case that doesn’t happen, House committees this week got down to work on a budget reconciliation bill that could pass the Senate with a …

KHN’s ‘What the Health?’: All About Budget Reconciliation Read More »

ACA Open Enrollment Matters for Medicaid Coverage, Too

President Biden’s January 28th executive order to reopen enrollment in the federal ACA Marketplace from February 15 through May 15, combined with $50 million in federal spending on outreach and education about ACA coverage options, has the potential to reach millions of people who were uninsured prior to or have lost coverage during the pandemic. …

ACA Open Enrollment Matters for Medicaid Coverage, Too Read More »

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’

Two in-home care providers — ConcertoHealth and Perfect Health — announced Wednesday that their organizations have merged. Together, the companies will operate under the name “ConcertoCare.” Aliso Viejo, California-based ConcertoHealth is a value-based care provider organization that delivers a variety of home-based care services. The company’s teams consist of complex care physicians, complex care nurses, …

In-Home Care Providers ConcertoHealth, Perfect Health Merge to Form ‘ConcertoCare’ Read More »

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan

What You Should Know: – Anthem, Inc. has entered into an agreement with InnovaCare Health, L.P., to acquire its Puerto Rico-based subsidiaries, including MMM Holdings, LLC (“MMM”) and its Medicare Advantage (MA) plan MMM Healthcare, LLC as well as affiliated companies and Medicaid plan.   – MMM is Puerto Rico’s largest MA plan and one …

Anthem Acquires Puerto Rico’s Largest Medicare Advantage Plan Read More »

Insurers shift medicine costs to patients with severe chronic illnesses

For many patients with complex and chronic conditions, high out-of-pocket costs for medicines pose a significant challenge. Recent research revealed a broken insurance system that fails to help those who need care most. New resources further demonstrate how patients with asthma, diabetes, HIV and cancer can face high out-of-pocket costs due to insurance design.

Use of Self-Directed Home Care Services Jumped 20% in 2020

Self-directed home care services are on the rise. Last year, many states created even more Medicaid flexibilities to allow seniors to essentially hire their own family members as their caregivers, which was especially helpful amid stay-at-home orders and fears surrounding COVID-19. On their end, states see this strategy as a win-win. Patients can be cared …

Use of Self-Directed Home Care Services Jumped 20% in 2020 Read More »

Humana Taps DispatchHealth to Power Hospital-Level Care in the Home

What You Should Know: – Humana Inc. and DispatchHealth, a provider of in-home medical care, today announced an agreement to provide Humana members with access to an advanced level of care in the home – to help enhance patients’ experience and health outcomes. The Dispatch-Humana agreement is believed to be the country’s first program to …

Humana Taps DispatchHealth to Power Hospital-Level Care in the Home Read More »

Tennessee’s Medicaid demonstration fails patients

Prior to its departure from office, the Trump Administration approved Tennessee’s request for a demonstration to change how the state’s Medicaid program operates, and more importantly, how vulnerable patients access the health care they need.

KHN’s ‘What the Health?’: The Long Road to Unwinding Trump Health Policies

Can’t see the audio player? Click here to listen on SoundCloud. Thursday was “health day” in President Joe Biden’s sprint to launch his presidency, and he signed two executive orders addressing health coverage and women’s reproductive rights. The orders will reopen enrollment under the Affordable Care Act from February to May and reverse the so-called Mexico …

KHN’s ‘What the Health?’: The Long Road to Unwinding Trump Health Policies Read More »

Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know

This data note discusses changes in the number of applications for Medicaid/CHIP coverage during the coronavirus pandemic. Although enrollment in Medicaid/CHIP has increased steadily by more than 6 million individuals (9%) from February to September 2020, the total number of Medicaid/CHIP applications has decreased by more than 150,000 (-6%) in the same time period. The …

Analyzing Recent Trends in Medicaid/CHIP Applications: What We Do and Do Not Know Read More »

Why CMS Will Lead the 2021 Kidney Care Revolution

Chris Riopelle, CEO of Strive Health After an unprecedented year, kidney care providers, including nephrologists, dialysis facilities, and care extenders are expecting 2021 to follow suit. We will see an overhaul in reimbursement and major industry shifts, partly led by CMS, that will require providers to advance their capabilities in a way that will usher …

Why CMS Will Lead the 2021 Kidney Care Revolution Read More »

Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends

As a result of the COVID-19 Public Health Emergency (PHE) , states have experienced increased enrollment along with administrative challenges. After the PHE ends, states are likely to have renewal and redetermination backlogs and will face decisions around continuing temporary policy changes. This brief highlights key issues from the new CMS guidance to states on …

Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends Read More »

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 2.2 million poor uninsured adults are in this situation. This brief presents estimates …

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid Read More »

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through September 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data show that total enrollment grew to 77.3 million in …

Analysis of Recent National Trends in Medicaid and CHIP Enrollment Read More »

KHN’s ‘What the Health?’: On Capitol Hill, Actions Have Consequences

Can’t see the audio player? Click here to listen on SoundCloud. The reverberations from the Jan. 6 storming of the U.S. Capitol by supporters of President Donald Trump continue. A broad array of business groups, including many from the health industry, are halting contributions to Republicans in the House and Senate who voted against certifying the …

KHN’s ‘What the Health?’: On Capitol Hill, Actions Have Consequences Read More »

Despite Efforts to Slow the Spread of the Virus in Long-Term Care Facilities, KFF Analysis Finds Many States Experienced the Worst COVID-19 Outbreaks and Highest Number of Deaths in December

For some regions of the country, recent months have brought the worst COVID-19 outbreaks in long-term care facilities since the start of the pandemic, a new KFF analysis of state-reported cases and death shows, underscoring the importance of current efforts to vaccinate this high priority group. The novel coronavirus has had a disproportionate impact on…More

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021

Dr. Gary Call, Chief Medical Officer at HMS As healthcare spending continues to rise, so too does the inherent risk for bad actors to take advantage. Today, the United States is estimated to spend nearly 18 percent of its GDP, or $3.6 trillion, on healthcare, and is expected to increase to one-fifth of GDP within …

Provider Strategies for Mitigating Telehealth Fraud & Abuse in 2021 Read More »

Net Health Acquires Post-Acute Analytics Platform PointRight – M&A

What You Should Know: –  Net Health acquires post-acute market analytics platform PointRight to deepen the company’s analytics capabilities, post-acute presence, and support for SNF networks. Net Health, a provider of cloud-based software for specialty medical providers across the continuum of care, today announced that it has acquired PointRight Inc., a leading provider of analytics …

Net Health Acquires Post-Acute Analytics Platform PointRight – M&A Read More »

California Budget Reflects ‘Pandemic-Induced Reality,’ Governor Says

USE OUR CONTENT It can be republished for free. SACRAMENTO, Calif. — The coronavirus pandemic doomed Gov. Gavin Newsom’s ambitious plans last year to combat homelessness, expand behavioral health services and create a state agency to control soaring health care costs. But even as the pandemic continues to rage, California’s Democratic governor said Friday he …

California Budget Reflects ‘Pandemic-Induced Reality,’ Governor Says Read More »

An Urban Hospital on the Brink Vs. the Officials Sworn to Save It

Illinois and Chicago officials are trying to figure out how to stop a private company from closing a money-losing urban hospital in a poor, underserved Chicago neighborhood. Trinity Health, a national Catholic tax-exempt chain, wants to close Mercy Hospital and Medical Center on Chicago’s Near South Side by May 31. Last month, in an unusual …

An Urban Hospital on the Brink Vs. the Officials Sworn to Save It Read More »

Trump Administration Approves First Medicaid Block Grant, in Tennessee

Use Our Content It can be republished for free. With just a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee that for the first time would give the state broad authority in running the health insurance program for the poor in exchange for capping …

Trump Administration Approves First Medicaid Block Grant, in Tennessee Read More »

COVID-19 Deferrals Lead to 3 Major Conditions Payers/Providers Must Address in 2021

What You Should Know: – COVID-19 care deferrals lead to three major boomerang conditions that payers and providers must proactively address in 2021, according to a newly released report by Prealize. – COVID-19’s hidden victims—those who avoided or deferred care during the pandemic—will increasingly return to the healthcare system, and many will be diagnosed with …

COVID-19 Deferrals Lead to 3 Major Conditions Payers/Providers Must Address in 2021 Read More »

Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados

Como jefa de enfermería en uno de los hospitales más concurridos de la red de seguridad de atención médica de Chicago, Raquel Prendkowski ha sido testigo del devastador número de víctimas que COVID-19 ha causado entre los residentes más vulnerables de la ciudad, incluyendo a personas que no tienen seguro médico por su estatus migratorio. …

Illinois, primer estado en ofrecer cobertura médica a adultos mayores indocumentados Read More »

Get Ready for a Lot of Biden Executive Orders on Health Care

In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.

Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors

As a nurse manager for one of Chicago’s busiest safety-net hospitals, Raquel Prendkowski has witnessed covid-19’s devastating toll on many of the city’s most vulnerable residents — including people who lack health insurance because of their immigration status. Some come in so sick they go right to intensive care. Some don’t survive. “We’re in a …

Illinois Is First in the Nation to Extend Health Coverage to Undocumented Seniors Read More »

January 14 Web Event: A Shot in the Arm For Long-Term Care Facilities? Early Lessons from the COVID-19 Vaccine Rollout to High Priority Populations

With the pandemic taking a heavy toll among older Americans, the Centers for Disease Control and Prevention and most states have placed a high priority on vaccinating residents and staff of long-term care facilities. People in nursing homes and other long-term care settings account for 8 percent of cases but 40 percent of deaths from…More

Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs

Ted Howard started taking Truvada a few years ago because he wanted to protect himself against HIV, the virus that causes AIDS. But the daily pill was so pricey he was seriously thinking about giving it up. Under his insurance plan, the former flight attendant and customer service instructor owed $500 in copayments every month …

Many Health Plans Now Must Cover Full Cost of Expensive HIV Prevention Drugs Read More »

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup

Dr. Paul Hain, Chief Medical Officer of GoHealth Telehealth is Here to Stay in 2021 Prior to the pandemic, telehealth was a limited ad-hoc service with geographic and provider restrictions. However, with both the pandemic restrictions on face to face interactions and a relaxation of governmental regulations, telehealth utilization has significantly increased from thousands of …

12 Telehealth & Virtual Care Predictions and Trends for 2021 Roundup Read More »

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021

As we close out the year, we asked several healthcare executives to share their predictions and trends for 2021. Kimberly Powell, Vice President & General Manager, NVIDIA Healthcare Federated Learning: The clinical community will increase their use of federated learning approaches to build robust AI models across various institutions, geographies, patient demographics, and medical scanners. The sensitivity and …

30 Executives Share Top Healthcare Predictions & Trends to Watch in 2021 Read More »

Two Women’s Health Policy Issues to Monitor in 2021

With President-elect Joe Biden and a new Congress taking office next month, newly updated KFF briefs examine two women’s health policy issues awaiting federal policymakers in 2021. President-elect Biden campaigned on reversing the Trump Administration’s regulations for the Title X family planning program, which require complete financial and physical separation from abortion services, including referrals,…More

Analysis of Recent National Trends in Medicaid and CHIP Enrollment

This data note looks at national and state-by-state Medicaid and CHIP preliminary enrollment data through August 2020, as states were still in the early stages of experiencing the health and economic effects of the coronavirus pandemic. After declines in enrollment from 2017 through 2019, preliminary data show that total enrollment grew to 76.5 million in …

Analysis of Recent National Trends in Medicaid and CHIP Enrollment Read More »

Community Health Centers’ Role in Delivering Care to the Nation’s Underserved Populations During the Coronavirus Pandemic

In the midst of the coronavirus pandemic, community health centers are serving as public health responders, especially for medically underserved populations. Health centers are a national network of safety net primary care providers who provided care to nearly 30 million patients in 2019, and disproportionately serve patients who are low-income, persons of color, uninsured, or …

Community Health Centers’ Role in Delivering Care to the Nation’s Underserved Populations During the Coronavirus Pandemic Read More »

Humana Taps Vida Health to Power Virtual Diabetes Management for Kentucky’s Medicaid Population

What You Should Know: –  Humana Healthy Horizons™ in Kentucky announced it has selected Vida Health’s virtual diabetes management program to serve Kentucky’s Medicaid population. – Vida’s diabetes management program achieves lasting results for participants. Because chronic conditions like diabetes, obesity, and hypertension often occur simultaneously, Vida’s unique program was built from the ground up to …

Humana Taps Vida Health to Power Virtual Diabetes Management for Kentucky’s Medicaid Population Read More »

KHN’s ‘What the Health?’: 2020 in Review — It Wasn’t All COVID

Can’t see the audio player? Click here to listen on SoundCloud. COVID-19 was the dominant — but not the only — health policy story of 2020. In this special year-in-review episode of KHN’s “What the Health?” podcast, panelists look back at some of the biggest non-coronavirus stories. Those included Supreme Court cases on the Affordable Care …

KHN’s ‘What the Health?’: 2020 in Review — It Wasn’t All COVID Read More »

For Better Patient Care Coordination, We Need Seamless Digital Communications

Catherine Thomas: Co-Founder and VP, Customer Engagement, careMESH  Peter Tippett MD, PhD: Founder and CEO, careMESH A recent Advisory Board briefing examined the annual Centers for Medicare & Medicaid Services (CMS) Readmission penalties.  Of the 3,080 hospitals CMS evaluated, 83% received a penalty for payments to be made in 2021, based on expected outcomes for a …

For Better Patient Care Coordination, We Need Seamless Digital Communications Read More »

Providers Scramble to Figure Out EVV as Implementation Date Inches Closer

When it comes to clinical and operational efforts, COVID-19 has been at the forefront for most home-based care providers. With the public health emergency top of mind, it may be easy to forget that new federal technology requirements — electronic visit verification (EVV), in particular — are right around the corner. Starting on Jan. 1 …

Providers Scramble to Figure Out EVV as Implementation Date Inches Closer Read More »

Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch

Federal legislation provides a temporary increase in federal Medicaid matching rates to states conditioned on states providing continuous eligibility for existing enrollees and meeting certain other eligibility requirements. This brief provides an overview of these maintenance of eligibility (MOE) requirements, examines what happens when the MOE expires, and discusses key issues to consider looking ahead.

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

As Telehealth Surges, Are Seniors Being Left Behind?

Anne Davis, Director of Quality Programs & Medicare Strategy at HMS A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and …

As Telehealth Surges, Are Seniors Being Left Behind? Read More »

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance

Courtney Tesvich, VP of Regulatory at Nextech When 2020 began, no one anticipated that complying with the Merit-based Incentive Payment System (MIPS)—the flagship payment model of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP)—would look so different halfway through the year. Like many other things, the COVID-19 crisis has delayed, diverted, …

Despite COVID-19: Providers Should Not Lose Sight of MIPS Compliance Read More »

Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity

What You Should Know: – Cityblock Health, a transformative, value-based healthcare provider focused on improving healthcare outcomes for marginalized communities, today announced a $160M Series C round, bringing its total raised to $300M. – Cityblock is a care delivery trailblazer working to right the injustices of a healthcare system that cycles vulnerable communities through frequent …

Cityblock Health Reaches $1B Valuation, Raises $160M to Address Systemic Healthcare Inequity Read More »

Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care

What You Should Know: – Elation Health, which provides an easy-to-use and affordable clinical technology platform for more than 7 million independent primary care clinicians serving 14M+ patients – including an EHR raises $40M in Series C funding from Al Gore’s sustainable investment firm, Generation Investment Management. – Elation’s API-enabled platform also allows organizations to …

Elation Health Nabs $40M for Clinical-First Solution to Power Independent Primary Care Read More »

Trump Plan May Set Clock Ticking on Many Health Rules — Setting Off Alarms

The Trump administration wants to require the Department of Health and Human Services to review most of its regulations by 2023 — and automatically void those not assessed in time. A proposed rule would require HHS to analyze within 24 months about 2,400 regulations — rules that affect tens of millions of Americans on everything …

Trump Plan May Set Clock Ticking on Many Health Rules — Setting Off Alarms Read More »

How Has the Pandemic Affected Health Coverage in the U.S.?

Findings from administrative data suggest that the decline in enrollment among employer-sponsored insurance was far less than overall declines in employment as of September, and that many who did lose their job-based coverage likely found a safety net in coverage through Medicaid or the ACA marketplaces.

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations

What You Should Know: – San Francisco-based digital health startup Pair Team emerges out of stealth with $2.7M in seed funding backed by Kleiner Perkins, Craft Ventures, & YC. – Pair Team provides both a remote team and AI that automates workflows, provides infrastructure & improves medical practices — efficiencies and billing as you’d expect, …

Pair Team Emerges Out of Stealth with $2.7M to Automate Primary Care Operations Read More »

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense

Don Godbee Don Godbee, Mobile Solutions Architect at Stratix Don Godbee Telehealth and virtual care are not brand-new phenomena suddenly cobbled together as a rapid response to the onset of the COVID-19 pandemic, but the average US patient could be forgiven for thinking that it is. Indeed, virtual visits to care providers and remote patient …

Ensuring Telehealth Providers’ Virtual Care Dollars Make Sense Read More »

Potential Health Policy Administrative Actions Under President Biden

This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.

5 Steps for Interoperability Excellence for Healthcare Providers

Shanti Wilson, Consultant, Freed Associates  As if 2020 couldn’t be any more challenging for healthcare providers, new federal rules on interoperability and patient access, granting patients direct access to their healthcare data, begin taking effect this November and continue into 2022. These rules, while ultimately beneficial to patients, bring an additional level of operational complexity to …

5 Steps for Interoperability Excellence for Healthcare Providers Read More »

California Lawmakers to Newsom: Give All Immigrants Health Coverage

Use Our Content It can be republished for free. SACRAMENTO — California Democratic lawmakers so far have failed to convince Gov. Gavin Newsom that the state can afford to spend an estimated $2.6 billion a year to expand its Medicaid program to all unauthorized immigrants. Now, they’re trying a new strategy. Rather than working independently, …

California Lawmakers to Newsom: Give All Immigrants Health Coverage Read More »

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status

What You Should Know: – CommonHealth has connected to 230 health systems in the United States, allowing patients to gather, manage and share their health and test data, including COVID test and vaccination status. By the end of this month, CommonHealth will connect to more than 340 health systems – CommonHealth extends the health data …

CommonHealth App Connects to 230 Health Systems to Share Health Data – including COVID Test and Vaccine Status Read More »

5 Myth-Busting New Hospital ADT Notification Requirements

 Claudia Williams, CEO of Manifest MedEx When doctors know their patients have been to the hospital, they can act fast to provide needed support. Widespread use of hospital event notifications is associated with all kinds of health benefits, including a 10 percent decrease in readmissions for Medicare beneficiaries. These event notifications are one of the …

5 Myth-Busting New Hospital ADT Notification Requirements Read More »

Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic

This data note looks at state Medicaid managed care enrollment data through September 2020 to assess the impact of the COVID-19 pandemic and economic crisis on Medicaid enrollment. Data collected for 30 states show Medicaid managed care enrollment increased to 11.3% from March 2020 through September 2020. The rate accelerated from the 4.1% reported for …

Growth in Medicaid MCO Enrollment during the COVID-19 Pandemic Read More »

COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts

Elizabeth Bierbower, Former President of Humana’s Group & Specialty Division Healthcare can achieve optimum efficiency when patients are at the center of care. When patients have the necessary information to navigate their care journey, they will choose the path to high-quality care at the lowest costs. Cost-sharing and insurance premiums are rising consistently since the …

COVID-19: How Can Payers Prepare for Mandates and Support Pandemic Relief Efforts Read More »

Millions of Uninsured Americans are Eligible for Free ACA Health Insurance

Amid the ongoing pandemic and high unemployment, this poste xamines how many uninsured people would be eligible for free health insurance during in a typical year, including those who qualify for Medicaid or for tax credits that cover the full cost of an ACA Marketplace plan.

Medicare Open Enrollment Is Complicated. Here’s How to Get Good Advice.

If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare. There are plenty of other Medicare ads, too, many set against a red-white-and-blue background meant to suggest officialdom — though if …

Medicare Open Enrollment Is Complicated. Here’s How to Get Good Advice. Read More »

CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes

On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in …

CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes Read More »

CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes

On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in …

CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes Read More »

Florida’s New Hospital Industry Head Ran Medicaid in State and Fought Expansion

With its choice of a new leader, the Florida Hospital Association has signaled that seeking legislative approval to expand Medicaid to nearly 850,000 uninsured adults won’t be among its top priorities. In October, Mary Mayhew became the association’s CEO. Mayhew, who led the state’s Medicaid agency since 2019, has been a vocal critic of the …

Florida’s New Hospital Industry Head Ran Medicaid in State and Fought Expansion Read More »

Patients Struggle to Find Prescription Opioids After NY Tax Drives Out Suppliers

NEW YORK — Mike Angevine lives in constant pain. For a decade the 37-year-old has relied on opioids to manage his chronic pancreatitis, a disease with no known cure. But in January, Angevine’s pharmacy on Long Island ran out of oxymorphone and he couldn’t find it at other drugstores. He fell into withdrawal and had …

Patients Struggle to Find Prescription Opioids After NY Tax Drives Out Suppliers Read More »

Red States’ Case Against ACA Hinges on Whether They Were Actually Harmed by the Law

Use Our Content It can be republished for free. Attorneys for GOP-controlled states seeking to kill the Affordable Care Act told the Supreme Court last week that at least some of the 12 million people who newly enrolled in Medicaid signed up only because of the law’s requirement that people have insurance coverage — although …

Red States’ Case Against ACA Hinges on Whether They Were Actually Harmed by the Law Read More »

8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent

Prasad Dindigal, Vice President, Healthcare & Life Sciences, EXL. Over the past few months, primarily as a result of the COVID-19 pandemic, telehealth has gone from a “nice-to-have” to a “must-have” for healthcare providers. The surge of COVID-19 patients in the spring, coupled with “stay-at-home” orders in many states, meant that many patients in need …

8 Ways Advanced Analytics Can Help You Decide If Telehealth Should Be Temporary or Permanent Read More »

AMA Unveils 2 Vaccine-Specific CPT Codes for Coronavirus Immunizations

What You Should Know: – The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2). – The new Category I CPT codes and long descriptors for the vaccine products 91300 and 91301 for better tracking, reporting, …

AMA Unveils 2 Vaccine-Specific CPT Codes for Coronavirus Immunizations Read More »